Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Long-Term Survival Outcomes of Elderly Patients Treated With S-1 or Capecitabine Plus Oxaliplatin for Stage II or III Gastric Cancer: A Multicenter Cohort Study

  • Choi, Seohee (Department of Surgery, National Health Insurance Service Ilsan Hospital) ;
  • Min, Jae-Seok (Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center) ;
  • Jeong, Sang-Ho (Department of Surgery, Gyeongsang National University School of Medicine) ;
  • Yoo, Moon-Won (Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Son, Young-Gil (Department of Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine) ;
  • Oh, Sung Jin (Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Kim, Jong-Han (Department of Surgery, Korea University College of Medicine) ;
  • Park, Joong-Min (Department of Surgery, Chung-Ang University College of Medicine) ;
  • Hur, Hoon (Department of Surgery, Ajou University School of Medicine) ;
  • Jee, Ye Seob (Department of Surgery, Dankook University Hospital) ;
  • Hwang, Sun-Hwi (Department of Surgery, Pusan National University Yangsan Hospital) ;
  • Jin, Sung-Ho (Department of Surgery, Korea Cancer Center Hospital) ;
  • Lee, Sang Eok (Department of Surgery, Konyang University Hospital) ;
  • Lee, Young-Joon (Department of Surgery, Gyeongsang National University School of Medicine) ;
  • Seo, Kyung Won (Department of Surgery, Kosin University College of Medicine) ;
  • Park, Sungsoo (Department of Surgery, Korea University College of Medicine) ;
  • Lee, Chang Min (Department of Surgery, Korea University College of Medicine) ;
  • Kim, Chang Hyun (Department of Surgery, G Sam Hospital) ;
  • Jeong, In Ho (Department of Surgery, Jeju National University Hospital) ;
  • Lee, Han Hong (Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Sung Il (Department of Surgery, Kyung Hee University Hospital at Gangdong) ;
  • Lee, Sang-Il (Department of Surgery, Chungnam National University College of Medicine) ;
  • Kim, Chan-Young (Department of Surgery, Jeonbuk National University College of Medicine) ;
  • Chae, Hyundong (Department of Surgery, Daegu Catholic University College of Medicine) ;
  • Son, Myoung-Won (Department of Surgery, Soonchunhyang University Cheonan Hospital) ;
  • Pak, Kyung Ho (Department of Surgery, Hallym University Dongtan Sacred Heart Hospital) ;
  • Kim, Sungsoo (Department of Surgery, Jeju National University Hospital) ;
  • Lee, Moon-Soo (Department of Surgery, Eulji University Hospital) ;
  • Kim, Hyoung-Il (Department of Surgery, Yonsei University College of Medicine)
  • Received : 2022.01.18
  • Accepted : 2022.02.22
  • Published : 2022.03.31
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Abstract

Purpose: Tegafur/gimeracil/oteracil (S-1) and capecitabine plus oxaliplatin (CAPOX) are standard adjuvant chemotherapies (ACs) administered after gastrectomy to patients with stage II or III gastric cancer. However, the efficacy of AC in elderly patients remains unclear. The objective of this retrospective multicenter cohort study was to compare the efficacies of S-1 and CAPOX AC in patients aged ≥70 years. Materials and Methods: Nine hundred eighty-three patients who were treated with AC using S-1 (768 patients) or CAPOX (215 patients) were enrolled in this study. Each patient underwent AC after curative gastrectomy for stage II or III gastric cancer at one of 27 hospitals in the Republic of Korea between January 2012 and December 2013. Relapse-free survival (RFS) and overall survival (OS) were analyzed according to AC regimen and age group. Results: Of the 983 patients, 254 (25.8%) were elderly. This group had a similar RFS (P=0.099) but significantly poorer OS (p=0.003) compared with the non-elderly group. Subgroup analysis of the non-elderly group revealed no AC-associated differences in survival. Subgroup analysis of the elderly group revealed significantly better survival in the S-1 group than in the CAPOX group (RFS, P<0.001; OS, P<0.001). Multivariate analysis revealed that the CAPOX regimen was an independent poor prognostic factor for RFS (hazard ratio [HR], 1.891; 95% confidence interval [CI], 1.072-3.333; P=0.028) and OS (HR, 2.970; 95% CI, 1.550-5.692; P=0.001). Conclusions: This multicenter observational cohort study found significant differences in RFS and OS between S-1 and CAPOX AC among patients with gastric cancer aged ≥70 years.

Keywords

Acknowledgement

This study was funded by the Korean Gastric Cancer Association, Republic of Korea (grant No. KGC0118C1) and the National Health Insurance Service, Ilsan Hospital (grant No. NHIMC2021CR069). We thank the members of the Surgical Oncology Forum (SOF) study group for their collaboration with this study.

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